Antibiotic Resistance among Enteric Fever Pathogens in a Tertiary Care Children Hospital of Bangladesh

Dhaka Shishu (Children) Hospital Journal Pub Date : 2021-01-28 DOI:10.3329/dshj.v35i1.51713

Md Mizanur Rahman, A. T. Bhuiyan

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Abstract

Background: Enteric fever, a public health problem endemic in Bangladesh involves multiple systems. Fluoroquinolones and third generation cephalosporins are first line drugs used in treatment, which has led to increased minimal inhibitory concentration (MIC) of ciprofloxacin causing therapeutic failure. In recent years using these drug some treatment failure found. Objectives: To study the antibiotic resistance among enteric fever pathogens in young children and to study the isolation rate of S. typhi and S. paratyphi among different age groups of children. Methods: A prospective study was done in Pediatric Infectious & Community Pediatrics Department of Dhaka shishu (Children) Hospital among admitted children age 1 to 15 years from January 2018 to January 2019. During this period 62 blood culture samples with growth of S.typhi & S.paratyphi were processed. The antibiotic susceptibility was done by modified Kirby disk diffusion. Results: During this 1 year from 72 admission days, 216 suspected enteric fever children admitted in Pediatric Infectious & Community Pediatric Department. Out of these 216 patients, isolation rate of enteric fever pathogens by blood cultures was 62 (28.7%). Majority of the isolates were S. typhi (75.8%) and S. paratyphi A were 24.2%. Among them 40(64.5%) isolates were from 5 to 15 years of age. Antibiotic resistance pattern was Ampicillin 37.1%, Chloramphenicol 30.64%, Co-trimoxazole 35.48%, Ceftriaxone (0%), Azithromycin (19.35%), resistance or reduced susceptibility to Ciprofloxacin was found in 77.41%, Nalidixic acid 100%, ten isolates (16.12%) were MDR. The most susceptible antibiotic was ceftriaxone while most resistant was nalidixic acid. Conclusion: The increasing numbers of enteric fever pathogens with decreasing susceptibility to ciprofloxacin and azithromycin is a concern. Increasing dependency to ceftriaxone and cefixime may cause resistance to these drugs near future. So, we can choose older drugs again in some cases. DS (Child) H J 2019; 35(1) : 55-58

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孟加拉国一家三级儿童医院肠道热病原体的抗生素耐药性

背景:肠热是孟加拉国流行的公共卫生问题，涉及多个系统。氟喹诺酮类药物和第三代头孢菌素是用于治疗的一线药物，这导致环丙沙星的最低抑制浓度(MIC)升高，导致治疗失败。近年来使用这些药物发现一些治疗失败。目的:了解幼儿肠道发热病原菌的耐药性及不同年龄组儿童伤寒沙门氏菌和副伤寒沙门氏菌的分离率。方法:对2018年1月至2019年1月在达卡shishu(儿童)医院儿科感染与社区儿科住院的1 - 15岁儿童进行前瞻性研究。在此期间，处理了62份有伤寒沙门氏菌和副伤寒沙门氏菌生长的血液培养样品。采用改良Kirby纸片扩散法进行药敏试验。结果:从72天起的1年内，儿科感染与社区儿科共收治疑似肠热患儿216例。216例患者中，经血培养分离出肠炎病原菌62例(28.7%)。以伤寒沙门氏菌(75.8%)和副伤寒沙门氏菌(24.2%)为主。其中40株(64.5%)为5 ~ 15岁分离株。抗生素耐药模式为氨苄西林37.1%、氯霉素30.64%、复方新诺明35.48%、头孢曲松(0%)、阿奇霉素(19.35%)，对环丙沙星耐药或降低药敏的占77.41%，对萘啶酸100%，耐多药10株(16.12%)。最敏感的抗生素是头孢曲松，最耐药的是萘啶酸。结论:肠道发热病原菌数量增加，对环丙沙星和阿奇霉素的敏感性下降，值得关注。对头孢曲松和头孢克肟依赖性的增加可能在不久的将来引起对这些药物的耐药性。所以，在某些情况下，我们可以再次选择老药。DS(儿童)hj 2019;35(1): 55-58

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Dhaka Shishu (Children) Hospital Journal

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